HR – Work Experience and Work Placement Request Work Experience and Work Placement Request 1Introduction2Request You can use this form to Request to join the Swan Hill Rural City Council’s Work Experience Program Who can use this form Students from approved educational institutions (usually public and private schools, TAFE, universities and other employment training organisations) While completing this form, we will request Student details Contact details Education details Placement details including work preferences Contact details for an endorsee e.g a teacher that will endorse your application. It will take about 10 minutes to complete this form. After you submit this form We will send you an email receipt to confirm we have received your request A member of our Human Resources team will contact you within two weeks of your application What happens with your information? Information requested on this form is required by Swan Hill Rural City Council in order to process your application. We will handle any personal information you provide on this form in accordance with the Privacy and Data Protection Act 2014. We record this information on our customer databases and make it available to relevant Council staff in line with our Privacy Statement. You can access your personal information by contacting our Privacy Officer. Student detailsName* Date of birth* DD slash MM slash YYYY Address* Phone number* Email address* Any special needs / limitations*▾YesNoPlease specify any special needs / limitations*Are you of Aboriginal or Torres Strait Islander descent?* Yes No Current educational information Name of institution* Course* Year of study* ie. Year 10 Placement requestWhich placement are you applying for?*▾Work ExperienceStructured Workplace LearningPractical PlacementTerm selectionWhich term would you like to complete your placement?*▾Term twoTerm threeTerm two dates - 2021* 26 April - 30 April 3 May - 7 May 10 May - 14 May 17 May - 21 May 24 May - 28 May 30 May - 4 June 7 June - 11 June 15 June - 18 June 21 June - 25 June Term three dates - 2021* 12 July - 16 July 19 July - 23 July 26 July - 30 July 2 August - 6 August 9 August - 13 August 16 August - 20 August 23 August - 27 August 30 August - 3 September 6 September - 10 September 13 September - 17 September Do you have any special requests?*Eg. Need more weeks, different start dates etc. ▾YesNoDescription of special requestThese requests will be considered, but only applicable if approved. What department would you like to work in? Please select one department from the 1st preference section. 2nd preference is optional.1st Preference Select a department Actions Edit Delete There are no 1st preference. Add 1st preference Maximum number of 1st preference reached. 2nd Preference Select a department Actions Edit Delete There are no 2nd Preference. Add 2nd Preference Maximum number of 2nd preference reached. Endorsee DetailsName* Position* Contact Number* Email* * I have notified my Endorsee that they will be contacted to confirm the application.* Student Declaration* I have read, understood and agree to abide by the conditions stated at the top of this form if offered a work experience placement at Swan Hill Rural City Council.*